Nephrology

Question 1

HCV associated glomerulonephritis

Answer 1

+cryoglobulins, HCV, RF, low C4, +RF, membranoproliferative glomerulonephritis with cryoglobulin depostion - palpable purpura, arthralgia, hypocomplement, periph neuropathy

Question 2

Asymptomatic hyponatremia

Answer 2

fluid restriction - does not have SIADH because urine sodium is low…

Question 3

HTN black patient with CKD

Answer 3

HTN kidney dz with proteinuria - add acei -

Question 4

Hypotonic hyponatremia

Answer 4

low solute intake - anorexia, wt loss - low urine osm/Na+, with less sodium - inhibits ability to excrete free water making hyponatremia worse

Question 5

Pseudohyponatremia

Answer 5

low serum Na concentration secondary to falsely elevated volume from large, space occupying solutes ie lipids, paraproteins - would have normal plasma osm and osmol gap

Question 6

Hypovolemic hyponatremia

Answer 6

postural changes in BP, high urine osm (body trying to hold onto as much water as possible)

Question 7

Hyponatremia with adrenal insuff

Answer 7

see low cortisol, dec mineralo/gluocorticoid - inc vasopressin -

Question 8

Pregnancy risk with reduced kidney fxn

Answer 8

r/o eclampsia/ARF - baseline GFR - recheck Creatnine as mode of assessment - PROTEINURIA, IgA, BP DO NOT PREDICT RISK

Question 9

Primary membranous glomerulnephropathy

Answer 9

HLD elev LDL with proteinuria - tx with statin and ACEi - if Age>50, male, elev Cr, HTN, secondary glomerulosclerosis, tubulointerstitial changes on bx then advanced to CKD - if child bearing age caution with ACEi - congential malformations - low risk no need for immunosupp initially

Question 10

Hypercalciuria with Calcium stones

Answer 10

thiazinde diuretic (chlorothaladone) - probably ca oxal stones - >300 Ca in urine, low Ca diet will INCREASE stones, alkalzyze urine with K Citrate not Na Citrate (increases U Ca) - but K Citrate may increase Ca Phos stones - less soluble in alkaline pH

Question 11

Tenofovir

Answer 11

prox RTA type 2 - UpH <5.5 so distal acidification preserved - also glycosuria with normal serum glucose and hypophosphatemia point to prox RTA problem - mech = mitox damage

Question 12

Laxative abuse

Answer 12

normal AG metabolic acidosis - bicarb losses exceed hypokalemic induce ammoniagenesis

Question 13

Trimethoprim in bactrim

Answer 13

increase Cr that is not reflective of worsening kidney fxn